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Open Access 12-04-2024 | Original Paper

Co-designing a Physical Activity Service for Refugees and Asylum Seekers Using an Experience-Based Co-design Framework

Authors: Grace McKeon, Jackie Curtis, Reza Rostami, Monika Sroba, Anna Farello, Rachel Morell, Zachary Steel, Mark Harris, Derrick Silove, Belinda Parmenter, Evan Matthews, Juliana Jamaluddin, Simon Rosenbaum

Published in: Journal of Immigrant and Minority Health

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Abstract

People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or ‘touchpoints’ including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing.
Literature
1.
go back to reference UNHCR. Global trends: forced displacement in 2020. The UN Refugee Agency. Geneva: 2021. UNHCR. Global trends: forced displacement in 2020. The UN Refugee Agency. Geneva: 2021.
2.
go back to reference Australian Government Department of Home Affairs. Australia’s humanitarian program: discussion paper. 2021–2022. Australian Government Department of Home Affairs. Australia’s humanitarian program: discussion paper. 2021–2022.
3.
go back to reference Hadgkiss EJ, Renzaho AM. The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: a systematic review of the literature. Aust Health Rev. 2014;38(2):142–59.CrossRefPubMed Hadgkiss EJ, Renzaho AM. The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: a systematic review of the literature. Aust Health Rev. 2014;38(2):142–59.CrossRefPubMed
4.
go back to reference Health N, Council MR. Cultural competency in health: a guide for policy, partnerships and participation. National Health and Medical Research Council. 2006. Health N, Council MR. Cultural competency in health: a guide for policy, partnerships and participation. National Health and Medical Research Council. 2006.
5.
go back to reference Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet. 2005;365(9467):1309–14.CrossRef Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet. 2005;365(9467):1309–14.CrossRef
6.
go back to reference Li SS, Liddell BJ, Nickerson A. The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Curr Psychiatry Rep. 2016;18(9):1–9.CrossRef Li SS, Liddell BJ, Nickerson A. The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Curr Psychiatry Rep. 2016;18(9):1–9.CrossRef
7.
go back to reference Harris M, Zwar N. Refugee health. Aust Fam Physician. 2005;34(10). Harris M, Zwar N. Refugee health. Aust Fam Physician. 2005;34(10).
8.
go back to reference Steel Z, et al. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537–49.CrossRefPubMed Steel Z, et al. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537–49.CrossRefPubMed
9.
go back to reference Hynie M. The social determinants of refugee mental health in the post-migration context: a critical review. Can J Psychiatry. 2018;63(5):297–303.CrossRefPubMed Hynie M. The social determinants of refugee mental health in the post-migration context: a critical review. Can J Psychiatry. 2018;63(5):297–303.CrossRefPubMed
10.
go back to reference Abur W, Mphande C. Mental health and wellbeing of South Sudanese-Australians. J Asian Afr Stud. 2020;55(3):412–28.CrossRef Abur W, Mphande C. Mental health and wellbeing of South Sudanese-Australians. J Asian Afr Stud. 2020;55(3):412–28.CrossRef
11.
go back to reference Taylor J, Lamaro HG. Influence of the social determinants of health on access to healthcare services among refugees in Australia. Aust J Prim Health. 2018;24(1):14–28.CrossRefPubMed Taylor J, Lamaro HG. Influence of the social determinants of health on access to healthcare services among refugees in Australia. Aust J Prim Health. 2018;24(1):14–28.CrossRefPubMed
12.
go back to reference Steel Z, et al. Impact of immigration detention and temporary protection on the mental health of refugees. Br J Psychiatry. 2006;188(1):58–64.CrossRefPubMed Steel Z, et al. Impact of immigration detention and temporary protection on the mental health of refugees. Br J Psychiatry. 2006;188(1):58–64.CrossRefPubMed
13.
go back to reference Blackmore R, et al. The prevalence of mental illness in refugees and asylum seekers: a systematic review and meta-analysis. PLoS Med. 2020;17(9): e1003337.CrossRefPubMedPubMedCentral Blackmore R, et al. The prevalence of mental illness in refugees and asylum seekers: a systematic review and meta-analysis. PLoS Med. 2020;17(9): e1003337.CrossRefPubMedPubMedCentral
14.
go back to reference Morina N, et al. The Association of post-traumatic and postmigration stress with pain and other somatic symptoms: an explorative analysis in traumatized refugees and asylum seekers. Pain Med. 2018;19(1):50–9.CrossRefPubMed Morina N, et al. The Association of post-traumatic and postmigration stress with pain and other somatic symptoms: an explorative analysis in traumatized refugees and asylum seekers. Pain Med. 2018;19(1):50–9.CrossRefPubMed
15.
go back to reference Maldari T, Elsley N, Abdul Rahim R. The health status of newly arrived Syrian refugees at the Refugee Health Service, South Australia, 2016. Aust J Gen Pract. 2019;48(7):480–6.CrossRefPubMed Maldari T, Elsley N, Abdul Rahim R. The health status of newly arrived Syrian refugees at the Refugee Health Service, South Australia, 2016. Aust J Gen Pract. 2019;48(7):480–6.CrossRefPubMed
16.
go back to reference Firth J, et al. A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020;19(3):360–80.CrossRefPubMedPubMedCentral Firth J, et al. A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020;19(3):360–80.CrossRefPubMedPubMedCentral
17.
go back to reference Schulenkorf N, Sherry E, Rowe K. Sport for development: an integrated literature review. J Sport Manag. 2016;30(1):22–39.CrossRef Schulenkorf N, Sherry E, Rowe K. Sport for development: an integrated literature review. J Sport Manag. 2016;30(1):22–39.CrossRef
18.
go back to reference Morgan L. The role of sport in assisting refugee settlement. Refugee Council of Australia (RCOA). 2008;75. Morgan L. The role of sport in assisting refugee settlement. Refugee Council of Australia (RCOA). 2008;75.
19.
go back to reference Murad S, Versey HS. Barriers to leisure-time social participation and community integration among Syrian and Iraqi refugees. Leis Stud. 2021;40(3):378–91.CrossRef Murad S, Versey HS. Barriers to leisure-time social participation and community integration among Syrian and Iraqi refugees. Leis Stud. 2021;40(3):378–91.CrossRef
20.
go back to reference Nilsson H, et al. Physical activity, post-traumatic stress disorder, and exposure to torture among asylum seekers in Sweden: a cross-sectional study. BMC Psychiatry. 2021;21(1):452.CrossRefPubMedPubMedCentral Nilsson H, et al. Physical activity, post-traumatic stress disorder, and exposure to torture among asylum seekers in Sweden: a cross-sectional study. BMC Psychiatry. 2021;21(1):452.CrossRefPubMedPubMedCentral
21.
go back to reference El Masri A, Kolt GS, George ES. Physical activity interventions among culturally and linguistically diverse populations: a systematic review. Ethn Health. 2022;27(1):40–60.CrossRefPubMed El Masri A, Kolt GS, George ES. Physical activity interventions among culturally and linguistically diverse populations: a systematic review. Ethn Health. 2022;27(1):40–60.CrossRefPubMed
22.
go back to reference Wieland ML, et al. Perspectives on physical activity among immigrants and refugees to a small urban community in Minnesota. J Immigr Minor Health. 2015;17(1):263–75.CrossRefPubMedPubMedCentral Wieland ML, et al. Perspectives on physical activity among immigrants and refugees to a small urban community in Minnesota. J Immigr Minor Health. 2015;17(1):263–75.CrossRefPubMedPubMedCentral
23.
go back to reference Agency for Clinical Innovation. A guide to build co-design capability: ACI. 2019. Agency for Clinical Innovation. A guide to build co-design capability: ACI. 2019.
24.
go back to reference O’Brien J, Fossey E, Palmer VJ. A scoping review of the use of co-design methods with culturally and linguistically diverse communities to improve or adapt mental health services. Health Soc Care Community. 2021;29(1):1–17.CrossRefPubMed O’Brien J, Fossey E, Palmer VJ. A scoping review of the use of co-design methods with culturally and linguistically diverse communities to improve or adapt mental health services. Health Soc Care Community. 2021;29(1):1–17.CrossRefPubMed
25.
go back to reference Walker L, et al. Co-producing a physical activity intervention with and for people with severe mental ill health–the spaces story. Qual Res Sport Exerc Health. 2023:1–13. Walker L, et al. Co-producing a physical activity intervention with and for people with severe mental ill health–the spaces story. Qual Res Sport Exerc Health. 2023:1–13.
26.
go back to reference Deenik J, et al. From impact factors to real impact: translating evidence on lifestyle interventions into routine mental health care. Transl Behav Med. 2020;10(4):1070–3.CrossRefPubMed Deenik J, et al. From impact factors to real impact: translating evidence on lifestyle interventions into routine mental health care. Transl Behav Med. 2020;10(4):1070–3.CrossRefPubMed
27.
go back to reference Simonsen CB, Ryom K. Building bridges: a co-creation intervention preparatory project based on female Syrian refugees’ experiences with physical activity. Action Res. 2023;21(4):382–401. Simonsen CB, Ryom K. Building bridges: a co-creation intervention preparatory project based on female Syrian refugees’ experiences with physical activity. Action Res. 2023;21(4):382–401.
28.
go back to reference Matthews E, Cowman M, Denieffe S. Using experience-based co-design for the development of physical activity provision in rehabilitation and recovery mental health care. J Psychiatr Ment Health Nurs. 2017;24(7):545–52.CrossRefPubMed Matthews E, Cowman M, Denieffe S. Using experience-based co-design for the development of physical activity provision in rehabilitation and recovery mental health care. J Psychiatr Ment Health Nurs. 2017;24(7):545–52.CrossRefPubMed
29.
go back to reference Dimopoulos-Bick T, et al. Experience-based co-design: tackling common challenges. J Health Des. 2018;3(1). Dimopoulos-Bick T, et al. Experience-based co-design: tackling common challenges. J Health Des. 2018;3(1).
30.
go back to reference Australian Healthcare & Hospital Association (AHHA). Experience based co-design toolkit. 2018. Australian Healthcare & Hospital Association (AHHA). Experience based co-design toolkit. 2018.
31.
go back to reference The Point of Care Foundation. EBCD: experience-based co-design toolkit. 2018. The Point of Care Foundation. EBCD: experience-based co-design toolkit. 2018.
32.
go back to reference Ogrinc G, et al. SQUIRE 2.0—Standards for Quality Improvement Reporting Excellence—revised publication guidelines from a detailed consensus process. J Am Coll Surg. 2016;222(3):317–23.CrossRefPubMed Ogrinc G, et al. SQUIRE 2.0—Standards for Quality Improvement Reporting Excellence—revised publication guidelines from a detailed consensus process. J Am Coll Surg. 2016;222(3):317–23.CrossRefPubMed
33.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
34.
go back to reference Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. BMJ Qual Saf. 2006;15(5):307–10.CrossRef Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. BMJ Qual Saf. 2006;15(5):307–10.CrossRef
35.
go back to reference Hartley L, Fleay C, Tye ME. Exploring physical activity engagement and barriers for asylum seekers in Australia coping with prolonged uncertainty and no right to work. Health Soc Care Community. 2017;25(3):1190–8.CrossRefPubMed Hartley L, Fleay C, Tye ME. Exploring physical activity engagement and barriers for asylum seekers in Australia coping with prolonged uncertainty and no right to work. Health Soc Care Community. 2017;25(3):1190–8.CrossRefPubMed
36.
go back to reference Caperchione CM, et al. Physical activity behaviours of Culturally and Linguistically Diverse (CALD) women living in Australia: a qualitative study of socio-cultural influences. BMC Public Health. 2011;11:26.CrossRefPubMedPubMedCentral Caperchione CM, et al. Physical activity behaviours of Culturally and Linguistically Diverse (CALD) women living in Australia: a qualitative study of socio-cultural influences. BMC Public Health. 2011;11:26.CrossRefPubMedPubMedCentral
37.
go back to reference Napier AD, et al. Culture and health. The Lancet. 2014;384(9954):1607–39.CrossRef Napier AD, et al. Culture and health. The Lancet. 2014;384(9954):1607–39.CrossRef
38.
go back to reference Smith R, Mansfield L, Wainwright E. ‘Do know harm’: Examining the intersecting capabilities of young people from refugee backgrounds through community sport and leisure programmes. Int Rev Sociol Sport. 2023:10126902221150123. Smith R, Mansfield L, Wainwright E. ‘Do know harm’: Examining the intersecting capabilities of young people from refugee backgrounds through community sport and leisure programmes. Int Rev Sociol Sport. 2023:10126902221150123.
39.
go back to reference Working Group of the Migrant and Refugee Women’s Health Partnership. Culturally responsive clinical practice: working with people from migrant and refugee backgrounds : competency standards framework for clinicians. January 2019. Migrant and Refugee Women's Health Partnership. 2019:44. Working Group of the Migrant and Refugee Women’s Health Partnership. Culturally responsive clinical practice: working with people from migrant and refugee backgrounds : competency standards framework for clinicians. January 2019. Migrant and Refugee Women's Health Partnership. 2019:44.
40.
go back to reference Australian Commission on Safety and Quality in Health Care. Resources for the NSQHS standards. Action 1.2.1: improving cultural competency. Australian Commission on Safety and Quality in Health Care. Resources for the NSQHS standards. Action 1.2.1: improving cultural competency.
41.
go back to reference Berry JW. Theories and models of acculturation. The Oxford handbook of acculturation and health. 2017: 15–28. Berry JW. Theories and models of acculturation. The Oxford handbook of acculturation and health. 2017: 15–28.
42.
go back to reference Middleton TRF, et al. Community sport and physical activity programs as sites of integration: a meta-synthesis of qualitative research conducted with forced migrants. Psychol Sport Exerc. 2020;51: 101769.CrossRef Middleton TRF, et al. Community sport and physical activity programs as sites of integration: a meta-synthesis of qualitative research conducted with forced migrants. Psychol Sport Exerc. 2020;51: 101769.CrossRef
43.
go back to reference Darroch F, et al. Trauma-informed approaches to physical activity: a scoping study. Complement Ther Clin Pract. 2020;41(3): 101224.CrossRefPubMed Darroch F, et al. Trauma-informed approaches to physical activity: a scoping study. Complement Ther Clin Pract. 2020;41(3): 101224.CrossRefPubMed
44.
go back to reference Bergholz L, Stafford E, D’Andrea W. Creating trauma-informed sports programming for traumatized youth: core principles for an adjunctive therapeutic approach. J Infant Child Adolesc Psychother. 2016;15(3):244–53.CrossRef Bergholz L, Stafford E, D’Andrea W. Creating trauma-informed sports programming for traumatized youth: core principles for an adjunctive therapeutic approach. J Infant Child Adolesc Psychother. 2016;15(3):244–53.CrossRef
45.
go back to reference Reis AC, et al. In search of a “vocabulary for recreation”: Leisure-time physical activity among humanitarian migrants in regional Australia. PLoS ONE. 2020;15(10): e0239747.CrossRefPubMedPubMedCentral Reis AC, et al. In search of a “vocabulary for recreation”: Leisure-time physical activity among humanitarian migrants in regional Australia. PLoS ONE. 2020;15(10): e0239747.CrossRefPubMedPubMedCentral
46.
go back to reference Nickerson A, et al. The association between visa insecurity and mental health, disability and social engagement in refugees living in Australia. Eur J Psychotraumatol. 2019;10(1):1688129.CrossRefPubMedPubMedCentral Nickerson A, et al. The association between visa insecurity and mental health, disability and social engagement in refugees living in Australia. Eur J Psychotraumatol. 2019;10(1):1688129.CrossRefPubMedPubMedCentral
47.
go back to reference Gibbs L, Block K. Promoting social inclusion through sport for refugee-background youth in Australia: analysing different participation models. Soc Incl. 2017;5(2):91–100.CrossRef Gibbs L, Block K. Promoting social inclusion through sport for refugee-background youth in Australia: analysing different participation models. Soc Incl. 2017;5(2):91–100.CrossRef
48.
go back to reference Nickerson A, et al. Longitudinal association between trust, psychological symptoms and community engagement in resettled refugees. Psychol Med. 2019;49(10):1661–9.CrossRefPubMed Nickerson A, et al. Longitudinal association between trust, psychological symptoms and community engagement in resettled refugees. Psychol Med. 2019;49(10):1661–9.CrossRefPubMed
49.
go back to reference Henderson S, Kendall E, See L. The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review. Health Soc Care Community. 2011;19(3):225–49.CrossRefPubMed Henderson S, Kendall E, See L. The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review. Health Soc Care Community. 2011;19(3):225–49.CrossRefPubMed
50.
go back to reference Donetto S, Tsianakas V, Robert G. Using Experience-based Co-design (EBCD) to improve the quality of healthcare: mapping where we are now and establishing future directions. London: King’s College London; 2014. p. 5–7. Donetto S, Tsianakas V, Robert G. Using Experience-based Co-design (EBCD) to improve the quality of healthcare: mapping where we are now and establishing future directions. London: King’s College London; 2014. p. 5–7.
51.
go back to reference Matthews EW, et al. Implementing experience-based co-design to develop a physical activity programme in recovery-focused outpatient mental health services. Int J Ther Rehabil. 2022;29(4):1–16.CrossRef Matthews EW, et al. Implementing experience-based co-design to develop a physical activity programme in recovery-focused outpatient mental health services. Int J Ther Rehabil. 2022;29(4):1–16.CrossRef
52.
go back to reference Adanu RM, Johnson TR. Migration and women’s health. Int J Gynecol Obstet. 2009;106(2):179–81.CrossRef Adanu RM, Johnson TR. Migration and women’s health. Int J Gynecol Obstet. 2009;106(2):179–81.CrossRef
Metadata
Title
Co-designing a Physical Activity Service for Refugees and Asylum Seekers Using an Experience-Based Co-design Framework
Authors
Grace McKeon
Jackie Curtis
Reza Rostami
Monika Sroba
Anna Farello
Rachel Morell
Zachary Steel
Mark Harris
Derrick Silove
Belinda Parmenter
Evan Matthews
Juliana Jamaluddin
Simon Rosenbaum
Publication date
12-04-2024
Publisher
Springer US
Published in
Journal of Immigrant and Minority Health
Print ISSN: 1557-1912
Electronic ISSN: 1557-1920
DOI
https://doi.org/10.1007/s10903-024-01587-5